PEDIATRICS II Integrated Management of Childhood Illness (IMCI) By: Elizabeth Reyes-Telado, M.D.

January 28, 2012 Don't forget that there is a past for every saint and there is a future for every sinner. Trans by: Kakay/Gelome Assess, Classify the Sick Young Infant Age 1 week up to 2 months: Young Infants 1 week to 2 months they die from serious bacterial infection General Signs Few movement Fever Low body temperature Case: Andres is a 3 week old infant. His weight is 3.6kg. He was brought to the clinic because of difficulty of breathing INFANT AT INITIAL VISIT History and PE Check for the following: - Signs of possible bacterial infection: Opthalmia Neonatorum from N. gonorrhea infection

ASK FOR DIARRHEA Parameters No signs Condition Well, alert Eyes Tears Mouth / Tongue Thirst Normal Present Moist Drinks normally, not thirsty Goes back quickly

Some signs Restless, irritable Sunken Absent Dry Thirsty, drinks eagerly Goes back slowly

Severe Lethargic or unconscious Very sunken and dry Absent Very dry Drinks poorly or not able to drink Goes back very slowly

Skin pinch

Check for the following: Feeding Problem Low Weight What do we ask: Any Difficulty in feeding Is infant breastfeeding Frequency in 24 hrs Other food/drinks given How often Amount What is used to feed the infant Feeding bottle Cup Assess Breastfeeding Signs of good attachment: Chin touching breast (very close) Mouth wide open Lower lip turned outward More areola visible above than below Not indicated when: Exclusively BF without difficulty Not low weight for age Not breasrfed Serious problem requiring referral Immunization o o o At birth: BCG, Hep B 6 weeks: DPT, OPV, Hep B nd 10 wks: 2 dose

Abnormally sleepy Pus from local site of infection Diarrhea Feeding problem or low weight Immunization Status Other problems

ASSESS AND CLASSIFY Classify ALL Young Infants Any of the following Signs Not feeeding well; or Convulsions; or Fast breathing = >60 bpm Severe chest in-drawing Fever (37.5C or above) Low body temperature less than 35.5 C Movement only when stimulated or no movement at all Umbilicus red; or Draining pus Skin pustules NONE of the signs of very severe disease or local bacterial infection

Classify As VERY SEVERE DISEASE

LOCAL BACTERIAL INFECTION Severe Disease or Local INFECTION UNLIKELY

Infant at initial visit Check for signs of possible bacterial infection Ask about diarrhea Check for feeding problem or low weight Check for immunization Assess for other problems Assess for other problems: *Pics of fungal infection (mouth), intercostal retractions, obtunded

CHECK FOR JAUNDICE Any jaundice if age less than 24 hrs or Yellow palms and soles at any age Jaundice appearing after 24 hrs of age and palms and soles not yellow No Jaundice

SEVERE JAUNDICE JAUNDICE NO JAUNDICE

Case: Andres is a 3 week old infant. His weight is 3.6 kg. His axillary temperature is 36.5 C. He was brought to the clinic because of difficulty of breathing. His mother says that andres has not had convulsion. The nurse counts 74 breaths per minute. And repeat count after 5 minutes is 70 per minute. He finds that Andres has a mild chest indrawing and nasal flaring, but no grunting. The fontanel does not bulge. No pus in the ears. Umbilicus is normal. There is no skin pustules. Andres is calm and awake, his movements are normal. He does not have diarrhea. Is there a danger sign? What is the infants problem? Classify andres? Convulsion Fast breathing Severe chest indrawing Nasal flaring Grunting Bulging fontanelle Pus draining from ears Umbilical redness Fever Low body temperature Many or severe skin pustules Abnormally sleepy Less than normal movement

Treatment: Supportive o Fluids o Nutritional support o Alleviations of symptoms Ear discharge\ Sore throat Mouth ulcers o Prevention of hypoglycemia Treatment: directed to cause: o Pneumonia o Diarrhea o Ear infection o Anemia o Convulsion Instruction/ Counsel: Appropriate drug and dosage for the weight Reasons for giving the drug Demonstrate Return demo by the mother o Ask to give the first dose When to follow-up Check mothers understanding Follow up: After 2-3 days-fever, diarrhea After 5 days- Pneumonia/ear infection After 14 days-anemia After one month for weight monitoring

Childs Name: Andres Age: 3 weeks old Weight: 3.6 kg Temperature: 36.5 C Initial Visit/ Follow-up: Initial What are the childs problem? DOB Presence of general danger signs: None Does the child have cough or difficulty of breathing RR: 74/min Mild chest indrawing Nasal flaring No grunting Signs of possible bacterial infection Pneumonia Does the child have diarrhea? Does the child have fever? Does the child have an ear problem? Check for nutritional status Check for anemia Check for the need for vitamin A Check for immunization None None None